Approximately 18.2 million people in the US are living with diabetes (DM). In 2002, the total direct cost of health service utilization by patients with DM was estimated to be 91.8 billion dollars. Patients with DM have significantly higher mean Emergency Department (ED) costs and hospital admission rates as compared to those without DM. The study will be conduced in South Carolina, where the highest ED utilization rates are among African Americans (AAs) with DM. Yet, no studies were found that examine ED use by AAs with diabetes from the perspective of care-seeking behaviors and patient reported symptoms. The overall goals of this proposed study are to document and understand the factors related to ED use, the reasons for and persons influencing care-seeking by AAs with a primary ED discharge diagnosis of ambulatory sensitive or uncomplicated diabetes, and to develop an evidence-based explanatory model that will be used for future intervention research. The specific aims are to identify and explore: 1. Reasons AAs with uncomplicated diabetes access the ED. 2. Factors including precipitating symptoms, and persons influencing decisions by AAs to seek ED care. 3. Beliefs, attitudes, behaviors, and outcomes related to health systems use and care management of DM and its complications. The primary method of study is grounded theory with dimensional analysis. While prior epidemiological work identifies a mismatch in ED usage patterns, it cannot offer an individually focused explanation of reasons care is sought, especially within the domains of a culturally appropriate diabetes care management model. In-depth, qualitative taped and transcribed interviews with AAs with previously diagnosed DM who utilize the ED for DM-related care will be analyzed for critical issues from the perspective of the patient. Health record reviews of care will be analyzed as qualitative data. All factors or dimensions of ED use will be identified for a sample of 20-30 users. The outcome will be a dimensional model of ED care-seeking factors and behaviors by AAs with DM and ambulatory-sensitive conditions. The model will be used in future research to develop and test a culturally relevant, evidence-based intervention program that will improve care and quality of life for AAs with DM in coastal South Carolina. [unreadable] [unreadable] [unreadable]